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The Implementation of Computerized Cognitive Behavioural Therapies in a Service User-Led, Third Sector Self Help Clinic

Published online by Cambridge University Press:  22 February 2011

Kate Cavanagh ,
Nick Seccombe  and
Nicky Lidbetter
Kate Cavanagh*
Affiliation:
University of Sussex, UK
Nick Seccombe
Affiliation:
Self Help Services, Manchester, UK
Nicky Lidbetter
Affiliation:
Self Help Services, Manchester, UK
*
Reprint requests to Kate Cavanagh, School of Psychology, University of Sussex, Falmer, East Sussex BN1 9QH, UK. E-mail: kate.cavanagh@sussex.ac.uk
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Abstract

Background and aims: The efficacy and effectiveness of a computerized cognitive behavioural therapy (CCBT) package, Beating the Blues, has been demonstrated in a large randomized controlled trial and several pragmatic studies in the National Health Service (NHS). The current study tests the generalizability of this finding to the implementation of CCBT in a service user-led, third sector Self Help Clinic. Method: 510 referrals for the Beating the Blues program were received over a 16 month period in routine care. The Patient Health Questionnaire Depression (PHQ-9) and Anxiety (GAD-7) Scales were administered pre-treatment and during each treatment session. The 10-item Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), Work and Social Adjustment Scale and Patient Experience Questionnaire were also administered pre-treatment and immediately on completing treatment. Results: More than two-thirds of referrals were suitable for treatment and completed a baseline assessment; 84% of these started the Beating the Blues program. Two-hundred and twenty-six people meeting caseness criteria at baseline completed at least two sessions of CCBT. Of these, 50% met recovery criteria at their final point of measurement. Completer and intention-to-treat analysis also demonstrated statistically and clinically significant improvements on key outcome measures. Conclusion: CCBT can be effectively implemented in a service user-led, third sector Self Help Clinic, increasing access to psychological therapies to meet local needs for tier two interventions for depression and anxiety.

Keywords

Computerized cognitive behavioural therapyCCBTself-helpincreasing access to psychological therapiesdepressionanxiety
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 39 , Issue 4 , July 2011 , pp. 427 - 442
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2011

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References

Andrews, G. and Titov, N. (2009). Hit and miss: innovation and dissemination of evidence based psychological treatments. Behaviour Research and Therapy, 47, 974–979.CrossRefGoogle ScholarPubMed
Bebbington, P., Meltzer, H., Brugha, T., Farrell, M., Jenkins, R., Ceresa, C. and Lewis, G. (2003). Unequal access and unmet need: neurotic disorders and the use of primary care services. International Review of Psychiatry, 15, 115–122CrossRefGoogle ScholarPubMed
Cavanagh, K., Shapiro, D., van den Berg, S., Dawson, J., Barkham, M. and Proudfoot, J. (2006). The effectiveness of computerized cognitive behavioural therapies in routine care. British Journal of Clinical Psychology, 45, 499–514.CrossRefGoogle ScholarPubMed
Cavanagh, K., Shapiro, D., van den Berg, S., Swain, S., Proudfoot, J. and Barkham, M. (2009). The acceptability of computer-aided cognitive behavioural therapy: a pragmatic study. Cognitive Behavioural Therapy, 8, 235–246.CrossRefGoogle Scholar
Chew, C. and Obsborne, S. P. (2009). Exploring strategic positioning in the UK charitable sector: emerging evidence from charitable organizations that provide public services. British Journal of Management, 20, 90–105.CrossRefGoogle Scholar
Chorpita, B. F. and Regan, J. (2009). Dissemination of effective mental health treatment procedures: maximizing the return on a significant investment. Behavior Research and Therapy, 47, 990–993.CrossRefGoogle ScholarPubMed
Clark, D. M., Layard, R., Smithies, R., Richards, D. A., Suckling, R. and Wright, B. (2009). Improving access to psychological therapy: initial evaluation of two UK demonstration sites. Behaviour Research and Therapy, 47, 910–920.CrossRefGoogle ScholarPubMed
Connell, J. and Barkham, M. (2007). CORE-10 User Manual, Version 1.1. Bath: CORE System Trust and CORE Information Management Systems Ltd.Google Scholar
Department of Health (2001). Treatment Choice in Psychological Therapies and Counselling: evidence based clinical practice guideline. London: Department of Health.Google Scholar
Department of Health (2007). Improving Access to Psychological Therapies (IAPT) Programme: Computerized Cognitive Behavioural Therapy (cCBT) implementation guidance. London: Department of Health.Google Scholar
Department of Health (2008a). Improving Access to Psychological Therapies (IAPT) Implementation Plan: national guidelines for regional delivery. London: Department of Health. Available at www.iapt.nhs.ukGoogle Scholar
Department of Health (2008b). Improving Access to Psychological Therapies (IAPT) Outcomes Toolkit 2008/9. London: Department of Health.Google Scholar
Department of Health (2009). Technical Guidance for IAPT Key Performance Indicators. London: Department of Health.Google Scholar
Gilbody, S., Richards, D. and Barkham, M. (2007). Diagnosing depression in primary care using self-completed instruments: UK validation of the PHQ-9 and CORE-OM. British Journal of General Practice, 57, 650–652.Google ScholarPubMed
Goldberg, D. and Huxley, P. (1992). Common Mental Disorders: a bio-social model. London: Routledge.Google Scholar
Kaltenthaler, E., Sutcliffe, P., Parry, G., Beverly, C. and Ferriter, M. (2008). The acceptability to patients of computerized cognitive behavioural therapy for depression: a systematic review. Psychological Medicine, 38, 1521–1530.CrossRefGoogle ScholarPubMed
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., Rush, J., Walters, E. E. and Wang, P. S. (2003). The epidemiology of Major Depressive Disorder. Journal of the American Medical Association, 289, 3095–3105.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.CrossRefGoogle ScholarPubMed
Learmouth, D., Trosh, J., Rai, S., Sewell, J. and Cavanagh, K. (2008). The role of computer-aided psychotherapy within an NHS CBT specialist service. Counselling and Psychotherapy Research, 8, 117–123.CrossRefGoogle Scholar
Marks, I. M., Cavanagh, K. and Gega, L. (2007) Hands on Help: computer-aided psychological therapies. London: Maudsley Monograph.CrossRefGoogle Scholar
Martin, A., Rief, W., Klaiberg, A. and Braehler, E. (2006) Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. General Hospital Psychiatry, 28, 71–77.CrossRefGoogle ScholarPubMed
Mataix-Cols, D., Cameron, R., Gega, L., Kenwright, M. and Marks, I. M. (2006). Effect of referral source on outcome with CBT self-help. Comprehensive Psychiatry, 47, 241–245.CrossRefGoogle Scholar
Mundt, J. C., Marks, I. M., Shear, K. and Greist, J. M. (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464.CrossRefGoogle Scholar
National Institute for Clinical Excellence (NICE) (2004a). Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalized anxiety disorder) in adults in primary, secondary and community care: NICE Guideline CG22. London: National Institute for Clinical Excellence (www.nice.org.uk).Google Scholar
National Institute for Clinical Excellence (NICE) (2004b). Depression: management of depression in primary and secondary care: NICE Guideline CG23. London: National Institute for Clinical Excellence (www.nice.org.uk).Google Scholar
National Institute for Health and Clinical Excellence (2006). Guidance on the Use of Computerized Cognitive Behavioural Therapy for Anxiety and Depression. Technology Appraisal No. 97. London: National Institute for Clinical Excellence.Google Scholar
National Institute for Health and Clinical Excellence (2009). Depression: management of depression in primary and secondary care - full guidance, CG90. London: National Institute for Clinical Excellence.Google Scholar
NHS Manchester and Manchester City Council (2008). Joint Strategic Needs Assessment. Manchester: Manchester City Council.Google Scholar
Office of National Statistics (2009). Adult Psychiatric Morbidity in England, 2007: results of a household survey. Leeds: NHS Information Centre.Google Scholar
Posternak, M. A. and Miller, I. (2001). Untreated short-term course of major depression: a meta-analysis of outcomes from studies using wait-list control groups. Journal of Affective Disorders, 66, 139–146.CrossRefGoogle ScholarPubMed
Proudfoot, J., Ryden, C., Everitt, B., Shapiro, D., Goldberg, D., Mann, A., et al. (2004). Clinical effectiveness of computer-aided cognitive behavioural therapy for anxiety and depression in primary care. British Journal of Psychiatry, 185, 56–62.CrossRefGoogle Scholar
Roth, A. and Fonagy, P. (2005). What Works for Whom? A critical review of psychotherapy research. New York: The Guilford Press.Google Scholar
Shafran, R., Clark, D. M., Fairburn, C. G., Arntz, A., Barlow, D. H., Ehlers, A., Freeston, M., Garety, P. A., Hollon, S. D., Ost, L. G., Salkovskis, P. M., Williams, J. M. G. and Wilson, G. T. (2009). Mind the gap: improving the dissemination of CBT. Behaviour Research and Therapy, 47, 902–909.CrossRefGoogle Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. and Lowe, B. (2006) A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166:1092–7.CrossRefGoogle ScholarPubMed
Streiner, D. L. and Geddes, J. R. (2001). Intention to treat analysis when there are missing data. Evidence-Based Mental Health, 4, 70–71.CrossRefGoogle ScholarPubMed
Tansella, M. and Thonicroft, G. (2009). Implementation science: understanding the translation of evidence into practice. The British Journal of Psychiatry, 195, 283–285.CrossRefGoogle ScholarPubMed
Tung-Hsueh Lui, E., Wan-Lan, C., Yi-Hwei, L., Chiao Han, W, TzeJing, M. and Hwei Shan, H. (2009) Exploring the efficacy of cognitive bibliotherapy and a potential mechanism of change in the treatment of depressive symptoms among the Chinese: a randomized controlled trial. Cognitive Therapy and Research, 33, 449–461.Google Scholar
Williams, C. and Martinez, R. (2008). Increasing access to CBT: stepped care and CBT self-help models in practice. Behavioural and Cognitive Psychotherapy, 36, 675–683.CrossRefGoogle Scholar
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